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18. Durations of Antibiotic Therapy and Factors Associated with Longer Than Recommended Durations for Common Ambulatory Infections in an Integrated Healthcare System

BACKGROUND: Duration of antibiotic therapy is an important focus for antibiotic stewardship, but the extent and drivers of excessive durations are not well understood. This project aimed to describe durations of therapy prescribed for common infections across the ambulatory care settings of an integ...

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Autores principales: Deida, Axel Vazquez, Shihadeh, Katherine C, Aragon, Deborah, Knepper, Bryan C, Jenkins, Timothy C
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7776017/
http://dx.doi.org/10.1093/ofid/ofaa417.017
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author Deida, Axel Vazquez
Shihadeh, Katherine C
Aragon, Deborah
Knepper, Bryan C
Jenkins, Timothy C
author_facet Deida, Axel Vazquez
Shihadeh, Katherine C
Aragon, Deborah
Knepper, Bryan C
Jenkins, Timothy C
author_sort Deida, Axel Vazquez
collection PubMed
description BACKGROUND: Duration of antibiotic therapy is an important focus for antibiotic stewardship, but the extent and drivers of excessive durations are not well understood. This project aimed to describe durations of therapy prescribed for common infections across the ambulatory care settings of an integrated healthcare system and identify factors associated with longer than recommended durations. METHODS: This was a retrospective, cross-sectional evaluation conducted from July 1, 2018 to June 30, 2019. We identified antibiotic prescriptions for adults age 18 years or older presenting to a Denver Health ambulatory care facility (urgent care, emergency department, family medicine clinic, or internal medicine clinic) for an infection with a recommended duration of therapy of 5 days or less based on institutional guidance. Infections included purulent and non-purulent cellulitis, uncomplicated subcutaneous abscess, acute bacterial sinusitis (ABS), acute otitis media (AOM), community acquired pneumonia, cystitis, and pyelonephritis treated with an indicated fluoroquinolone. Prescriptions for more than 5 days were classified as longer than recommended. We evaluated whether the following factors were associated with longer than recommended prescriptions: location of visit, type of infection, patients’ age, race/ethnicity, sex, infection type, and prescribing provider type RESULTS: 5331 prescriptions met inclusion criteria. Of those, the duration of therapy was longer than recommended for 2095 (39%) (Table 1). Durations varied significantly across locations (p< 0.0001). In the sub-group analysis family medicine clinics had the highest proportion of longer than recommended durations (46%). Durations also varied significantly by type of infection. For cellulitis, ABS, and AOM, the duration was longer than recommended in 50%, 54%, and 75% of cases, respectively. Other factors associated with longer than recommended durations included male sex (p< 0.0001) and prescriptions by advanced practice providers (p = 0.0008). Table 1: Antibiotic Duration of Therapy for Common Outpatient Infections CONCLUSION: Care locations, infection types, and both patient and prescriber factors were associated with longer than recommended prescriptions suggesting specific opportunities to prevent excessive durations of therapy. [Image: see text] DISCLOSURES: All Authors: No reported disclosures
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spelling pubmed-77760172021-01-07 18. Durations of Antibiotic Therapy and Factors Associated with Longer Than Recommended Durations for Common Ambulatory Infections in an Integrated Healthcare System Deida, Axel Vazquez Shihadeh, Katherine C Aragon, Deborah Knepper, Bryan C Jenkins, Timothy C Open Forum Infect Dis Oral Abstracts BACKGROUND: Duration of antibiotic therapy is an important focus for antibiotic stewardship, but the extent and drivers of excessive durations are not well understood. This project aimed to describe durations of therapy prescribed for common infections across the ambulatory care settings of an integrated healthcare system and identify factors associated with longer than recommended durations. METHODS: This was a retrospective, cross-sectional evaluation conducted from July 1, 2018 to June 30, 2019. We identified antibiotic prescriptions for adults age 18 years or older presenting to a Denver Health ambulatory care facility (urgent care, emergency department, family medicine clinic, or internal medicine clinic) for an infection with a recommended duration of therapy of 5 days or less based on institutional guidance. Infections included purulent and non-purulent cellulitis, uncomplicated subcutaneous abscess, acute bacterial sinusitis (ABS), acute otitis media (AOM), community acquired pneumonia, cystitis, and pyelonephritis treated with an indicated fluoroquinolone. Prescriptions for more than 5 days were classified as longer than recommended. We evaluated whether the following factors were associated with longer than recommended prescriptions: location of visit, type of infection, patients’ age, race/ethnicity, sex, infection type, and prescribing provider type RESULTS: 5331 prescriptions met inclusion criteria. Of those, the duration of therapy was longer than recommended for 2095 (39%) (Table 1). Durations varied significantly across locations (p< 0.0001). In the sub-group analysis family medicine clinics had the highest proportion of longer than recommended durations (46%). Durations also varied significantly by type of infection. For cellulitis, ABS, and AOM, the duration was longer than recommended in 50%, 54%, and 75% of cases, respectively. Other factors associated with longer than recommended durations included male sex (p< 0.0001) and prescriptions by advanced practice providers (p = 0.0008). Table 1: Antibiotic Duration of Therapy for Common Outpatient Infections CONCLUSION: Care locations, infection types, and both patient and prescriber factors were associated with longer than recommended prescriptions suggesting specific opportunities to prevent excessive durations of therapy. [Image: see text] DISCLOSURES: All Authors: No reported disclosures Oxford University Press 2020-12-31 /pmc/articles/PMC7776017/ http://dx.doi.org/10.1093/ofid/ofaa417.017 Text en © The Author 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Oral Abstracts
Deida, Axel Vazquez
Shihadeh, Katherine C
Aragon, Deborah
Knepper, Bryan C
Jenkins, Timothy C
18. Durations of Antibiotic Therapy and Factors Associated with Longer Than Recommended Durations for Common Ambulatory Infections in an Integrated Healthcare System
title 18. Durations of Antibiotic Therapy and Factors Associated with Longer Than Recommended Durations for Common Ambulatory Infections in an Integrated Healthcare System
title_full 18. Durations of Antibiotic Therapy and Factors Associated with Longer Than Recommended Durations for Common Ambulatory Infections in an Integrated Healthcare System
title_fullStr 18. Durations of Antibiotic Therapy and Factors Associated with Longer Than Recommended Durations for Common Ambulatory Infections in an Integrated Healthcare System
title_full_unstemmed 18. Durations of Antibiotic Therapy and Factors Associated with Longer Than Recommended Durations for Common Ambulatory Infections in an Integrated Healthcare System
title_short 18. Durations of Antibiotic Therapy and Factors Associated with Longer Than Recommended Durations for Common Ambulatory Infections in an Integrated Healthcare System
title_sort 18. durations of antibiotic therapy and factors associated with longer than recommended durations for common ambulatory infections in an integrated healthcare system
topic Oral Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7776017/
http://dx.doi.org/10.1093/ofid/ofaa417.017
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